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Oct 29, 2022 449 likes •597 views

Management Of Elderly Patients With Clostridium Difficile Infections: Observational Data Of The French Survey CLOdi Arnaud CAUPENNE, Gaetan GAVAZZI, Marc PACCALIN University of Poitiers, FRANCE Intergroupe GInGer CONFLICT OF INTEREST

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Management Of Elderly Patients With Clostridium Difficile Infections: Observational Data Of The French Survey CLOdi

Arnaud CAUPENNE, Gaetan GAVAZZI, Marc PACCALIN University of Poitiers, FRANCE Intergroupe GInGer

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CONFLICT OF INTEREST DISCLOSURE

I have no potential conflict of interest to report

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BACKGROUND

First cause of nosocomial diarrhea
Incidence: 2.28/10000 hospitalized patients-day (national french

study)

Eckert, 2013

Recurrence and mortality estimated respectively 10 to 30% and

5 to 40%

Surawicz, 2015 ; Garey, 2008 ; Johnson, 2009

Assessment of risk factors and therapeutic practices for severe

CDI are heterogeneous.

Abou Chakra, 2014 ; Le Guern, 2013 ; Surawicz, 2013 ; Debast, 2014

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RECOMMANDATIONS ESCMID 2013

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AIMS

To assess prognosis of elderly patients with CDI
To report observational data collected during hospitalization

and therapeutic regimen regarding to the European recommendations

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PATIENTS AND METHODS

French survey CLOdi: prospective observational multicentric

study

Inclusions: hospitalized patients aged ≥75 with CDI
70 investigators in 31 French hospital centers
Inclusion: between march 2016 and may 2017
Online survey focused on clinical criteria of severity, and CDI

therapeutic support

Systematic follow-up at 3 months

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PRELIMINARY RESULTS

Characteristics of the population

260 patients
Mean age: 87.1 ± 5.5 [75-99]
Female: 65%
Coming from home (83%) and nursing home (17%)
CIRS-G score: 12.54 ± 6.4 [2-34] (comorbidities)
71% hospitalized in the past 12 months
60% treated with antibiotic in the last 3 months

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Characteristics of the infection

Nosocomial: 68.2%
At the time of diagnosis
Diarrhea: 88%
Antibiotic: 44% among 60.5% were stopped
Control measure
isolation precaution: 94.5%

RESULTS

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Severity criteria N (%) Fever > 38,5°C 44 (16.9%) Rigors 8 (3.1%) Sepsis 12 (4.6%) Leucocyte count > 15 x 109/L 74 (28.5%) Créatinine > 50% above the baseline 53 (20.4%) Albumin < 30 g/L 135 (51.9%) Kalemia < 3,5 mmol/L 52 (20%) Distension of large intestine > 6 cm 1 (0.4%) Pseudomembranous colitis 6 (2.3%) Septic shock 3 (1.2%) Ileus 6 (2.3%)

SEVERITY

197 (75,7%) patients with at least one severity marker (ESCMID)

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FIRST INTENTION TREATMENT

[VALORE] (51.2%) [VALORE] (36.9%) [VALORE] (10%) [VALORE] (1.2%)

20 40 60 80 100 120 140

Metronidazol Vancomycin Fidaxomicin Association of antibiotics

Nbr patients Antibiotics

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EVOLUTION

Mean duration of isolation precaution (days) 11.8 ± 9.73 [0-82] Mean duration of antibiotic therapy (days) 11.6 ± 5.78 [0-67] Healing 187 (71.9%) Surgery 1 (0.4%) Death

Death during the antibiotic treatment
Death after the infection

45 (17.3%)

21 (8.1%) 24 (9.2%)

In-hospitalization recurrence 31 (11.9%)

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CONCLUSION

Our study shows high rate of severe infection in older patients
Metronidazol is the first intention therapy in 51% cases
Rate of early recurrence and mortality are close to literature

data

The results highlight the lack of adequacy between antibiotic

used and the European guidelines

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Thanks to investigators

PARIS Dr Moulias Pr Rouveix Dr Greffe Dr Breining Dr Durand-Gasselin TREVOUX Dr Pietropaoli Dr Marechal DIJON Pr Piroth Dr Putot AIX Dr Puigserver Dr Maulin ROUEN Dr Renaudier Dr Guignery-Kadri Dr Kloul LYON Dr Federico Dr Gaujard Dr Martin Gaujard Dr Albrand Dr Chala hayet ALES Dr Fraisse MONTPELLIER Dr Terminet Pr Jeandel ANGERS Dr Tremblay Nguyen Dr Pignon NICE Dr Turpin Dr Mondain Dr Arlaud CLERMONT FERRAND Dr Dadet COLMAR Dr Dardalhon Dr Hauler SAINT ETIENNE Dr Dascalita

NIMES Pr de Wazieres (invest) Dr Viala Maurice (invest)

TOURS Pr Bernard Dr Lamande ORLEANS Dr Bourgeois BLOIS Dr Geffroy Dr Friocourt PERPIGNAN Dr Eden Dr Silga CHAMBERY Dr Forestier GRENOBLE Dr Pavese Pr Gavazzi ANNECY Dr Piet ROCHEFORT Dr Chartier CHATELLERA ULT Dr Gazali NIORT Dr Kahlifa SAINT YVI Dr Jestin BORDEAUX Dr Bourdel-Marchasson Dr Dubos VENDEE Dr Pelerin Dr Martin Dr Fevrier Dr Decours Dr Guimard Dr Morier Saint GALMIER Dr Carriere PLAISIR Dr Aribi BELLEY Dr Bard DUNKERQUE Dr Berode DIEPPE Dr Suel LANDERNEAU Dr Merrien ANGOULEME Dr Jarry